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Will the Military Be Ready to Deal with PTSD in Women?

The U.S. military announced the end of its policy excluding women from combat and will open combat jobs and direct combat units to female troops. The historic change overturns a 1994 rule prohibiting women from being assigned to smaller ground combat units. Many questions remain unanswered, especially in regards to how this change will actually be implemented. Among the numerous questions involved in this transition: Will direct combat stress levels effect women differently than men?

After last week’s fatal shooting of Chris Kyle, a retired Navy SEAL and author of the book American Sniper, we are once again reminded of the lingering emotional effects from military service. Kyle was attempting to help Eddie Ray Routh, a 25-year-old Marine reservist, who had been suffering from post-traumatic stress disorder (PTSD).

PTSD is a type of anxiety disorder. It can occur after you've seen or experienced a traumatic event that involved the threat of injury or death such as an interpersonal event like physical or sexual assault, exposure to disaster or accidents, combat or witnessing a traumatic event. Symptoms include continually re-living the event, emotional numbing or debilitation from a combination of the first two symptoms.

According to the U.S. National Library of Medicine, both psychological therapy (counseling) and pharmacotherapy (drugs) have been used to treat PTSD and guidelines suggest that a combination of both may mean people recover from PTSD more effectively. Their research included four trials following 124 participants. The trials all used anti-depressants and prolonged exposure or a cognitive behavioral intervention. The study concluded that “there is not enough evidence available to support or refute the effectiveness of combined psychological therapy and pharmacotherapy compared to either of these interventions alone.” Dr. Farris Tuma, with the National Institute of Health, acknowledged that many suffering from PTSD are "essentially using their own experience and maybe something they've read about. But the bottom line is ... we don't have good guidance for them."

As the military expands the role of women to include direct combat, what do we know about their ability to handle the increased stress? Previous research has looked at the effects of “all types of potentially traumatic events” on women, such as sexual assault and car accidents, and found that women are more than twice as likely to develop PTSD than men. However, a new study by Dawne Vogt, a MED associate professor of psychiatry and a researcher at the National Center for Post-Traumatic Stress Disorder in the VA Boston Healthcare System, found no such disparity in trauma from combat. But the study only included 340 women and 252 men who had returned from deployment within the previous year, quizzing them about any symptoms of depression, substance abuse, post-traumatic stress disorder, and other mental health impairment. And while servicewomen have certainly been exposed to a variety of positions that put them at risk, they have not previously been engaged in direct ground combat positions, so there is basically no empirical data to measure the effects.

Many questions remain about the expansion of women into direct combat. Will women be assigned to combat units or allowed to volunteer? In the unlikely event the U.S. would re-institute a draft, would female direct combat duty be automatic? In the midst of all the unknowns related to the policy change, the question remains: Is the military prepared to deal with the potential increase of PTSD in female soldiers? Considering their current inadequacy in treating PTSD in men, I am less than confident that the answer to that question is “yes.”